EAGLE EXPRESS SOCCER CLUB
Your player has been offered a place on "Boys Eagle Express 97 Fury"
To accept this offer, complete this form, and return it to the registrar.
Permission To Roster Form
ALL BLANKS MUST BE FILLED COMPLETELY
"Boys Eagle Express 97 Fury" Under 14 Boys / Team Coach: Barry VonLobstein
Date of Birth: _____________________ ID #: _____________________________________
Player’s Full Name: __________________________________________________________
Name Called: _____________________________ Home Phone: ______________________
Father’s name: ____________________________ Work Phone: _______________________
Father’s home number if different from player’s Home: ______________________________
Mother’s name: ___________________________ Work Phone: _______________________
Mother’s home number if different from player’s Home: _____________________________
Family E-mail(‘s): ___________________________________________________________
Address: ___________________________________________________________________
City: ________________________ St: ______ Zip: __________
I, (we) the parent/legal guardian of the above player, a minor, agree that the player and I (we) will abide
by the rules of “Boys Eagle Express 97 Fury”, “Eagle Express Soccer Club”, “Donelson District”,
Tennessee State Soccer Association and USYSA, its affiliated organizations and sponsors. Recognizing
the possibility of physical injury associated with soccer and in consideration for “Boys Eagle Express 97
Fury”, “Eagle Express Soccer Club”, “Donelson District”, Tennessee State Soccer Association and
USYSA accepting the above named registrant for its soccer programs and activities, I hereby agree to
assume the risk of and hold harmless, release, discharge and/or other wise indemnify the “Boys Eagle
Express 97 Fury”, “Eagle Express Soccer Club”, “Donelson District”, Tennessee State Soccer
Association and USYSA, their affiliated organizations and sponsors, their employees and associated
personnel, including the owners of the fields and facilities utilized for the programs, against any claim by
or on behalf of the registrant, as a result of their participation in the programs and/or being transported to
or from the same. I also authorize transportation convenient or necessary to and from any athletic event or
social event connected with this club.
Parent /Legal Guardian’s
Signature___________________________________________Date:___________________
Player’s Signature____________________________________Date:___________________
Coach’s Signature____________________________________Date:___________________
By signing this form I give “Boys Eagle Express 97 Fury”, “Eagle Express Soccer Club”, permission to
register my son/daughter to play for the above team for the TS August 1, 2010 - July 31, 2010 seasonal
year.
*** I understand that as a player/parent that I do not have to commit to any association,
team, or coach during the open period and I can not be punished by trying out for any
other association, team, or coach during this period ***